Evaluation and management of well-appearing, otherwise healthy febrile infants ≤90 days of age with bronchiolitis

RSV: respiratory syncytial virus; UTI: urinary tract infection; LE: leukocyte esterase; WBCs: white blood cells; HPF: high-power field.
* Rapid RSV testing is not required to make the diagnosis of bronchiolitis.
¶ Urine tests should be obtained by bladder catheterization or suprapubic aspiration. Some experts also recommend a complete blood count with differential, a blood culture, and, for patients with abnormal inflammatory markers, intravenous antibiotics and hospital admission.
Δ Empiric antibiotics should be adjusted based upon susceptibility of organisms in the region. Although risk of bacteremia is low in well-appearing febrile infants who are 29 to 90 days of age with a UTI, some clinicians may choose to perform a complete blood count with differential, a blood culture, and, especially for patients with abnormal inflammatory markers or those who have not received conjugate vaccines (infants 42 days of age and older), intravenous antibiotics and hospital admission. Refer to UpToDate content on treatment of UTI in infants and children.
◊ Refer to UpToDate content on treatment of bronchiolitis in infants for indications for hospitalization. Young infants with non-severe bronchiolitis who are hydrated and have adequate oral intake may be discharged home with close follow-up in 24 to 48 hours.